v3.25.4
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Cash flows from operating activities      
Net income $ 24,076 $ 49,932 $ 57,849
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 45,749 27,927 17,748
Amortization of debt issuance cost 4,050 1,828 1,061
Share-based compensation 38,601 34,536 22,040
Non-cash lease expense 6,647 5,278 7,183
Deferred tax (4,287) (4,249) (12,444)
Change in fair value of contingent consideration liabilities 5,166 3,526  
Other (2,307) (2,967) (1,822)
Changes in operating assets and liabilities, net of business combinations      
Receivables, net (9,424) (35,765) (20,568)
Other receivables 2,261 24,670 311
Prepaid expenses and other current assets 4,718 (10,854) (2,956)
Other assets 3,505 (8,875) 2,864
Accounts payable and accrued expenses (6,994) (30,919) (170)
Fiduciary accounts payable (4,699) 487 (328)
Medical liabilities 8,890 10,570 18,610
Income taxes payable/receivable 5,326 (8,622) (14,477)
Operating lease liabilities (6,049) (4,825) (6,674)
Other liabilities (632) 520 0
Net cash provided by operating activities 114,597 52,198 68,227
Cash flows from investing activities      
Payments for business and asset acquisition, net of cash acquired (548,604) (146,260) (6,512)
Purchases of investments – equity method 0 (5,968) (325)
Purchase of call option issued in conjunction with equity method investment 0 (3,907) 0
Issuance of loans receivable (1,708) (26,000) (26,473)
Purchases of property and equipment (10,106) (8,031) (28,529)
Proceeds from sale of equity method investment 15,100 0 0
Other 6,319 (2,229) (3,684)
Net cash used in investing activities (538,999) (192,395) (65,523)
Cash flows from financing activities      
Dividends paid (7,885) (4,036) (62,074)
Repayments on debt (495,289) (18,500) (204,681)
Borrowings on debt 1,119,300 171,875 284,527
Taxes paid from net share settlement of restricted stock (6,169) (4,662) 0
Repurchase of treasury shares (15,429) (937) (10,192)
Deferred financing cost (19,205) 0 (3,928)
Payment of financing obligation 0 (8,542) 0
Payment of contingent consideration liabilities (8,284) (518) (1,000)
Other 2,307 466 769
Net cash provided by financing activities 569,346 135,146 3,421
Net (decrease) increase in cash, cash equivalents, and restricted cash 144,944 (5,051) 6,125
Cash, cash equivalents, and restricted cash, beginning of year 289,101 294,152 288,027
Cash, cash equivalents, and restricted cash, end of year 434,045 289,101 294,152
Supplemental disclosures of cash flow information      
Cash paid for income taxes   43,936 56,567
Cash paid for interest 45,767 30,419 14,251
Supplemental disclosures of non-cash investing and financing activities      
Right-of-use assets obtained in exchange for operating lease liabilities 11,875 14,117 25,124
Common stock issued in business combination 0 21,952 800
Common stock issued for contingent consideration payment 2,600 4,023 0
Acquisition of business through loan conversion 0 5,175 0
Draw on letter of credit through Revolver Loan 0 4,732 0
Tax impact from APC dividends to APC Shareholders 0 0 3,076
Distribution of real estate investments 0 0 152,767
Effective settlement of note payable upon consolidation 9,488 0 0
Transfer of investment in privately held to equity method 6,000 0 0
Repurchase of treasury shares outstanding payable 922 0 0
Dividend paid in form of stock 21,935 0 0
Reconciliation of cash, cash equivalents, and restricted cash      
Cash and cash equivalents 429,474 288,455 293,807
Restricted cash 4,571 646 345
Total cash, cash equivalents and restricted cash shown in the statement of cash flows $ 434,045 $ 289,101 $ 294,152

Source

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